Prevalence of chemopreventive agent use among hospitalised women at high risk for breast cancer: a cross-sectional study

Objective: To characterise the current usage of chemoprevention agents among hospitalised women who are at higher risk for breast cancer. Study design: A cross-sectional study. Setting: Academic hospital at Baltimore. Participants: A bedside survey of 250 women aged 50-75 years was conducted who were cancer-free at the time of study enrolment and hospitalised to a general medicine service. Reproductive history, family history for breast cancer, chemopreventive agents use and medical comorbidities data was collected for all patients. chi(2) and t-tests were used to analyse population characteristics. Primary outcome measures: Prevalence of women at high risk for developing breast cancer (5-year Gail risk score >= 1.7) and their chemopreventive agent use. Results: Mean age for the study population was 61.5 years (SD 7.5), and mean 5-year Gail risk score was 1.67 (SD 0.88). A third of study population was at high risk for breast cancer. None of the high-risk women (0%) were taking chemoprevention for breast cancer risk reduction, and 23% were at very high risk with 5-year Gail score >= 3%. These women were not recognised as being high risk by their hospital providers and none were referred to the high-risk breast cancer clinics following discharge. Conclusions: Many hospitalised women are at high risk for breast cancer and we could not identify even a single woman who was using chemoprevention for risk reduction. Current chemoprevention guidelines may be falling short in their dissemination and implementation. Since women at high risk for breast cancer may only interface with the healthcare system at select points, all healthcare providers must be willing and able to do risk assessment. For those identified to be at high risk, providers must then either engage in chemopreventive counselling or refer patients to providers who are more comfortable working with patients on this critical decision.